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Since the start of this year, I’ve had the opportunity to conduct in-depth qualitative research across several different specialty and rare disease categories employing our Habit Lens methodology. And as I’ve sat across from healthcare providers (HCPs), sometimes for an hour, sometimes longer, listening to them speak candidly and open-endedly about how they actually practice medicine, one thing has become impossible to ignore:
Environment shapes behavior far more than most marketing research acknowledges. Not just the disease itself, but the entire domain in which the physician operates.
Their workflows. Their patient mix. Their emotional burden. Their time pressure. Their institutional systems. Their staffing support. Their relationships with patients. Their accumulated experiences of success and failure. These things are not always asked about directly in research, yet they surface constantly because they quietly shape almost every decision the physician makes.
In other words: context.
HCP habits, or anyone’s habits, for that matter, simply cannot be understood outside of the environments in which they arise.
This has become one of the foundational ideas within Habit Lens and, increasingly, one of the greatest opportunities in pharmaceutical marketing research. Because when we fail to intentionally and systematically unpack the context in which HCPs operate, we often fail to truly understand why they behave the way they do.
And when behavior is misunderstood, strategy is often built on incomplete, or entirely incorrect, assumptions.
One of the things that differentiates Habit Lens from other behavioral frameworks is our contention that habits are deeply contextual.
Charles Duhigg’s cue-routine-reward loop and Nir Eyal’s Hook Model are both enormously valuable. We draw from them constantly. But increasingly, I’ve come to believe that many behavioral frameworks underweight the importance of the domain in which the behavior actually occurs.
Habits are not abstract. They arise inside environments.
Now for a more down-to-earth example.
The driver’s seat of a car is a context. The shower in your home is a context. Your kitchen in the morning is a context. The grocery store is a context. These environments are full of familiar cues that activate highly routinized, automatic behaviors with very little conscious effort.
Medical practice in a clinical setting works much the same way.
A physician’s practice is an intensely conditioned behavioral (and social) environment where routines emerge as adaptive responses to complexity, time pressure, risk, emotional burden, as well as operational and financial constraints.
If our objective in marketing research is to understand HCP behavior, and ultimately to impact it, then thoroughly understanding that domain becomes absolutely essential.
One of the first contextual dimensions we explore in Habit Lens research is simple exposure frequency. How often does the physician actually encounter the condition?
This matters enormously.
A “bread and butter” condition creates a very different behavioral environment than a rare disease. In high-frequency categories, physicians have constant opportunities to reinforce routines, experiment with and trial new approaches, establish confidence, and strengthen habits through repetition. Repetition is the fuel of habit.
Rare diseases behave very differently.
Take pulmonary arterial hypertension or hereditary angioedema. In these settings, physicians may only encounter a limited number of patients, but the clinical and emotional stakes are extraordinarily high. The providers often know these patients intimately and follow them longitudinally over many years. Due to the fact that opportunities to use newer therapies arise less frequently, there are fewer repetitions through which confidence can develop behaviorally. Every treatment decision carries greater psychological weight. Thus, a physician might become more cautious, more deliberate, and often more reliant on deeply trusted routines and referral networks.
That creates a very different context for habit formation.
Now compare that to metastatic prostate cancer, where treatment paradigms have evolved rapidly with the emergence of novel hormonal agents, PSMA imaging, radioligand therapies, and biomarker-driven approaches. Despite the scientific complexity, many oncologists and urologists still describe highly structured and repeatable treatment pathways because they encounter similar clinical situations over and over again:
Over time, these scenarios themselves become cues. The physician recognizes the pattern almost immediately and begins journeying through familiar cognitive and behavioral pathways.
That is habit formation happening within a context.
Another major contextual dimension is risk. Some therapeutic areas are behaviorally forgiving. Others are not.
The higher the perceived risk surrounding a decision, the more behavioral gravity established routines tend to carry.
In oncology, hematology, transplant medicine, cardiology, or critical care, the consequences of failure feel significant and immediate. Under those conditions, physicians often become more conservative behaviorally. Familiarity and trust become extraordinarily important.
This is why products in high-risk categories often require much stronger conviction before they become incorporated into routine practice.
Importantly, “risk” is not purely clinical. Physicians also assess:
All of these shape behavior.
One of the most overlooked aspects of physician context is the patient themselves. Not simply their diagnosis, but the physician’s interpretation of who they are.
A young mother with aggressive breast cancer creates a different emotional and cognitive environment, or space, than an older patient with multiple chronic co-morbidities. A newly diagnosed patient creates a different sense of urgency than someone deep into a refractory disease journey.
These patient characteristics become cues.
They activate empathy, concern, urgency, caution, aggressiveness, or restraint. They shape how strongly the physician feels compelled to act.
And importantly, these reactions are filtered through belief systems, which I wrote about in a previous article.
These are thorny subjects. But they surface repeatedly in qualitative research when conversations become sufficiently open and nuanced.
And they matter strategically.
Another enormously important contextual layer is time.
Modern medicine is profoundly time constrained. Physicians are moving rapidly through highly compressed interactions while juggling documentation, reimbursement, patient education, and clinical decision-making simultaneously. Hence the high rates of burnout.
Under these conditions, prioritization itself becomes habitual.
Certain issues rise automatically to the top of the agenda while others recede. Some disease states or severities of that disease state command immediate cognitive attention; others become secondary.
This is not a flaw in medicine. It is adaptive efficiency.
And importantly, these prioritization habits differ by specialty, setting, disease category, severity and/or level of disease control.
Understanding those prioritization dynamics is critical to understanding why some therapeutic messaging might resonate while others fail to penetrate. This is all part of what we look at when we unpack context in a Habit Lens study.
Context also includes the operational architecture surrounding care delivery itself.
Is the physician operating in:
Does the office have:
These operational realities shape behavior constantly. A therapy that feels highly feasible in one environment may feel behaviorally impossible in another.
This is why “fit within workflow” has become one of the most important dimensions we examine in Habit Lens work.
So how do we operationalize all of this in marketing research? Increasingly, we approach context almost as a taxonomy, a structured set of dimensions that together shape behavior:
Once those contextual layers are properly understood, physician behavior often becomes dramatically easier to interpret.
The prescribing pattern that initially seemed irrational suddenly makes sense. The resistance to adopting a new therapy becomes understandable. The hidden barriers reveal themselves. And importantly, the strategic opportunities become much clearer.
To be clear, pharmaceutical marketing research already does a very good job exploring many aspects of physician context. We routinely examine workflow, patient mix, institutional dynamics, reimbursement realities, treatment pathways, and emotional burden. These dimensions are absolutely recognized within good qualitative and quantitative research.
What I believe Habit Lens adds is a more deliberate and structured way of organizing these contextual layers behaviorally.
Rather than treating context simply as surrounding information, Habit Lens attempts to unpack the physical, operational, emotional, and psychological dimensions of the environment in which physician behaviors actually arise. It encourages us to look more systematically at the interaction between:
Physician behavior rarely emerges from product attributes alone. It emerges from the interaction between all of these contextual forces unfolding simultaneously inside the treatment environment.
And if we truly want to understand why certain behaviors become automatic, trusted, and deeply ingrained, we need to fully understand the domain in which those habits reside.
